心脏再同步化起搏治疗随访

Follow-up of cardiac resynchronization pacing therapy for refractory heart failure.

目的探讨心脏再同步化起搏治疗（CRT）随访的相关技术细节。方法22例难治性充血性心力衰竭（简称心衰）患者（男14例、女8例），年龄59．5±7．8（47～74）岁，其中扩张型心肌病16例、高血压性心脏病6例。按常规方法置入双室起搏器后，按一定程序对起搏系统及患者的临床综合反应随访观察，根据患者反应及时对起搏系统参数进行优化。结果随访22±13．01（1～48）个月，双室起搏辅以优化的起搏参数及药物治疗。心衰临床症状改善，心功能提高，运动耐量增加，生活质量提高，心脏重塑进程延缓，因心衰住院事件减少。结论CRT必须从置入起搏器的即刻开始进行动态随访、优化起搏参数。

Objective To study the follow-up effect of cardiac resynchronous therapy （CRT） for refractory heart failure. Methods Twenty-four patients with refractory heart failure （RHF） were as follows： Male 14,female 8,aged 47-74 （59.5± 7.8） years. Sixteen of them had dilated cardiomyopathy and 6 cardiomyopathy was induced by essential hypertension. All the patients had indication of CRT. All patients were given right atrium and biventricular or sole biventricular pacing, and received strict follow-up and the pacing parameters were optimized dynamically in order. Results The patients mean follow-up duration was 22.0 ± 13. 01 months （ 1-48 ） months. By optimizing pacing parameters individually and rational medication, CRT could reverse ventricular remodeling, and decrease hospitalization event and mortality for heart failure. At the same time, patients＇clinic symptoms, heart function, quality of life （QOL） and distance of 6 minutes walk test （6MWT） had improved significantly. Furthermore, the all observed index were statistically significant. Conclusions Compared with ordinary pacemaker, biventricular pacing has some special characteristics. Therefore , dynamic following-up and individual parameter optimization are the key to successful CRT.